Provider Demographics
NPI:1669085346
Name:KINETIC PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:KINETIC PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-940-1247
Mailing Address - Street 1:8355 CROSSLAND LOOP
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8483
Mailing Address - Country:US
Mailing Address - Phone:334-270-1630
Mailing Address - Fax:334-313-8990
Practice Address - Street 1:15582 HIGHWAY 280 STE 114
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-8361
Practice Address - Country:US
Practice Address - Phone:205-940-1247
Practice Address - Fax:334-730-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty